Active NPI
Phyllis Graham, TEACHER
- Early Intervention Provider Agency
- Bronx, NY
National Provider Identifier
1326292244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Early Intervention Provider Agency
- License
- 20-4097009
- Practice address
- 100 Dekruif Place
#22J
Bronx, NY 10475-2419 - Phone
- (646) 408-6497
- Fax
- (718) 671-7976
- NPI assigned
- Nov 5, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Early Intervention Provider Agency | 252Y00000X | 20-4097009 | NY | Primary |
Addresses
Primary practice location
100 Dekruif Place
#22J
Bronx, NY 10475-2419
Mailing address
100 Dekruif Place
22J
Bronx, NY 10475-2419
Phone (646) 408-6497
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20-4097009 | NY | MD | Early Intervention Provider Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225843200000",
"number": "1326292244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 DEKRUIF PLACE",
"address_2": "22J",
"city": "BRONX",
"state": "NY",
"postal_code": "104752419",
"telephone_number": "646-408-6497",
"fax_number": "718-671-7976"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 DEKRUIF PLACE",
"address_2": "#22J",
"city": "BRONX",
"state": "NY",
"postal_code": "104752419",
"telephone_number": "646-408-6497",
"fax_number": "718-671-7976"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "PHYLLIS",
"name_prefix": "Mrs.",
"credential": "TEACHER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-11-05",
"last_updated": "2008-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "252Y00000X",
"taxonomy_group": "",
"desc": "Early Intervention Provider Agency",
"state": "NY",
"license": "20-4097009",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.